MMQB: Were Phoenix VA Officials a real life Death Panel?

While the media is only focusing on the secret list, it is time to ask whether or not those who created that list were, in practice, a death panel.

We know the secret list, in itself, was not a death panel – it was a secret scheduling list with names on it. However, I believe we need to evaluate if the unelected bureaucrats who directed the creation of the list may be a constructive death panel.

Veterans were waiting 6 to 21 months for appointments, depending on circumstances and criteria that is as of yet unclear. If VA engaged in an illegal scheme that rationed health care, the Phoenix VAMC likely then had a death panel, at least unofficially.

In light of the number of scandals across VA for similar activities, the question needs to be asked, not just at Phoenix VAMC but across the country.

We will get into this discussion and more during this Monday Morning Quarterback for Veterans. I am your host, Benjamin Krause, creator of DisabledVeterans.org.

Here are the topics we will cover:

Summary of what happened in Phoenix VAMC

Definition of a death panel

Did VA Phoenix have a death panel?

Official response from Phoenix VAMC

Official response from VA Central Office

House Committee Hearings

What happened at the Phoenix VA Health Care System

We know through numerous sources that Phoenix VA had a scandal going as high as the head of the VAMC. Officials at the VA created an elaborate scheme to hide between 1,400 to 1,600 veterans from its official appointment list.

While waiting, many urgent health care matters were allowed to go unchecked causing many veterans to die. Dr. Sam Foote, a long time VA employee, was the primary whistleblower in the case.

According to Dr. Foote, “The scheme was deliberately put in place to avoid the VA’s own internal rules.” Dr. Foote said VA officials instructed staff to bypass the primary computer systems to avoid creating an official record when veterans sought appointments. They would take a screen shot of the information entered into the computer, print it, and delete that electronic record.

The information on the screen shot printout was then entered into a secret software database outside VA’s primary database. Once an opening for a veteran’s appointment came within the 14-day window, Phoenix VAMC staff would then move the record from the secret database into the normal VA system.

Here is what this means in function to a well paid VA director and related officials. The effect of the illegal scheme was VA officials could keep costs down while meeting targets for appointments. As a result, they would still get bonuses for high performance even though veterans were not getting appointments in a timely manner. The lack of appointments also allowed them to keep costs down because VA officials would not need to keep staff numbers at appropriate levels.

Reports claim a core group of high-level individuals were at the center of the scandal. In order to pull off such a scheme, the director, heads of health care, heads of IT, and numerous others at high levels may have been involved or at least had knowledge of the activity. The elaborate nature of the scheme and how it integrated with VA’s Aspire database system suggests involvement from numerous high-level officials and regular staff.

What has not been disclosed is how VA’s secret database and secret list would allocate appointments within the scheduling system. Since veterans were waiting 6 to 21 months, it suggests that some internal criteria were in place.

Officials may have used certain metrics to allocate appointments based on particular criteria ahead of other veterans. For example, veterans needing obvious procedures may have been put ahead of veterans with terminal conditions or less obvious ailments. Effectively, this is a form of rationing health care rather than providing care when needed.

Or, the illegal scheme could have merely been a first-in, first-out kind of system. This would mean a veteran coming in for an appointment in September would merely be pushed off until the next appointment available opening months later. However, they would still wind up in the secret list.

By using either technique, VA officials made their performance levels look better. This obviously impacted bonuses and other benefits. It also resulted in veterans not getting health care in a reasonable amount of time, and in some veteran dying.

“Death Panel” aka Independent Payment Advisory Panel defined

To get at this, we need to have a commonly excepted definition.

Our Definition: A death panel is a group of unelected bureaucrats who decide who would get what care when. It means the patient has little to know control over the process. It also implies that some people will not get care at all times, which means the care is rationed by a group of unelected bureaucrats. Rationing could result in death at times.

According to The Hill, when the Affordable Care Act (ACA) was proposed, there was a lot of hype about the Act having a provision for a death panel. Sarah Palin and other Republicans then coined the term, in 2009.

The correct term for these cost-cutting boards is Independent Payment Advisory Board (IPAB), and they came back into the public conversation last year.

Back in 2009, Palin was called a liar when she highlighted the issue, but later investigations suggested certain provisions of the cost-cutting board in the ACA could hypothetically result in rationed care, which could lead to death.

“Though I was called a liar for calling it like it is, many of these accusers finally saw that ObamaCare did in fact create a panel of faceless bureaucrats who have the power to make life and death decisions about healthcare funding,” Palin wrote on Facebook.

Howard Dean, a former presidential candidate and medical doctor, later confirmed Palin’s claim in an op-ed. There, Dean argued that the IPAB would result in health care under Medicare being rationed.

True or not true, it seems like a relevant question to pose to the issue here of secret lists and veterans having health care withheld from them. Rationed health care does result in deaths, as we know from VA Medical Centers across the country. The question here is was the rationing intentional?

Did a death panel create the secret list?

The secret list was not a death panel. It was a scheduling list that did result in the death of many veterans. The criteria for the list was created by a group of bureaucrats who in turn had their staff implement the list.

The bureaucrats clearly rationed the health care to keep costs down while allowing them to collect bonuses. Since the rationed health care created by this group did kill veterans, it seems like a small leap to conclude VA did have a death panel.

The conclusion of the VA OIG investigation will hopefully shed some light on the criteria used by those VA officials. If they rationed health care in a deliberated way that was more deliberate than a first-in, first-out scheme, I think we know the answer.

However, if it was merely a callous and outrageous first-in, first-out appointment system, then officials in charge were just a bunch of criminals.

Here are VA’s official statements on the matter.

Official Response of Phoenix VA Health Care System

The Phoenix VA Health Care System is committed to delivering the highest quality care to Veterans. We have conducted robust internal reviews since these allegations surfaced and welcome the results from the Office of Inspector General’s review. We take these allegations seriously.

We acknowledge Phoenix VA Health Care System has had longstanding issues with Veterans accessing care and have taken numerous actions to meet demand, while we continue to serve more Veterans and enhance our services . To ensure new Veterans waiting for appointments are managed appropriately, we maintain an Electronic Wait List (EWL) in accordance with the national VHA Scheduling Directive.

The ability of new and established patients to get more timely care has showed significant improvement in the last two years, which is attributable to increased budget, staffing, efficiency and infrastructure. We continue to make improvements to further reduce wait times for Veterans. Veterans who have concerns about their care, should call the Patient Advocate at 602-277-5551, ext. 6171 or 6172.

Phoenix VA Health Care System cares deeply for every Veteran we are privileged to serve. As we continue to improve, we focus our work on Veterans to keep true to VA’s mission.

Official Response of VA Central

WASHINGTON – The Department of Veterans Affairs (VA) cares deeply for every Veteran we are privileged to serve, and we are committed to delivering the highest quality care. We take any allegations about patient care or employee misconduct very seriously, which is why the Department invited the independent VA Office of the Inspector General (OIG) to complete a comprehensive review at the Phoenix VA Health Care System as quickly as possible. VA also sent a team of clinical experts to Phoenix to review appointment scheduling procedures at that facility and the existence of any delays in care.

VA believes it is important to allow the Inspector General’s independent, objective review to proceed. We trust that the Inspector General will complete that comprehensive review as quickly as possible. These allegations, if true, are absolutely unacceptable and if the Inspector General’s investigation substantiates these claims, VA will take swift and appropriate action.

Veterans deserve to have full faith in their VA health care. VA facilities are committed to transparency and undergo multiple external, independent reviews every year to ensure its safety and quality. We appreciate the continued hard work and dedication of our employees and of the community stakeholders we work with every day in our service to Veterans.

ABOUT FOUNDER
Benjamin Krause is a lawyer, investigative reporter and award-winning veterans advocate. He is author of the guide Voc Rehab Survival Guide for Veterans and chief editor of DisabledVeterans.org.
He received his Bachelors from Northwestern University and Law Degree from the University of Minnesota, both using VA Vocational Rehabilitation and Employment.
He is also featured regularly in national publications as an authority on Department of Veterans Affairs policy such as Bloomberg News, Foreign Policy Magazine, Washington Times, Fox News, CBS, NBC, Star Tribune and more.
_____________________________________________________________

The official response is the most chilling facet of this whole thing to my eyes. It includes not one shred of actual honest response to the accusations, and no contrition, no concern for the families of the dead veterans, just typical VA obfuscation and stonewalling. I served in the US Army from 1967 through 1975. Never once in all of the decades since then, under either of our political parties, have I ever seen the VA tell the truth about anything. Not once.

This sort of thing is going to continue to happen to veterans. The VA is never going to change. The politicians have sold out their souls to the corporate elite and don’t care about veterans. It’s time to take the VA out of Congressional oversight and hold them accountable to the court system

THIS IS TYPICAL VA “DO NOT BELIEVE WHAT YOU SEE, BELIEVE WHAT WE TELL YOU IT IS”. AFTER 25 YEARS OF THAT FOR ONLY A 50% RATING, NO AGENT ORANGE CMPENSATION(EVEN THOUGH OTHERS THAT I KNOW FROM THE AREA I SERVED IN VIET NAM HAVE BEEN COMPENSATED), AND VARIOUS OTHER ATTEPTS TO “MEDICXATE” MY SYMPTOMS OVER THE YEARS, I FEEL AS THOUGH I HAVE BEEN CLASSIFIED AS A “COLD WAR ENEMY”. THE VA “EXPERIMENTS”, STONEWALLS WHEN CAUGHT, AND JUST BASICALLY HAS A CAVALIER ATTITUDE TOWARDS MOST VETS. THOSE WHO MAKE IT THROUGH ARE EITHER “PART OF” THE SYSTEM OR BETTER AT “CHEATING THE SYSTEM”. THOSE WHO HAVE BEEN TRULY AFFECTED BY OUR SERVICE TO OUR COUNTRY ARE LEFT TO FEND FOR OURSELVES. PTSD HAS A “FAR MORE DEBILITATING” EFFECT ON VETS, BUT THE PEOPLE THAT KNOW THESE “FACTS” ARE BOUGHT OFF OR DISMISSED. TO ASK A “SICK” PERSON TO TELL YOU WHAT IS “WRONG” WITH THEM, IS LIKE ASKING A “DEAD MAN(OR WOMAN) TO TESTIFY AT THEIR MURDER TRIAL. WE DO NOT “KNOW” THE ANSWERS AND THE DEAD CAN NOT “SPEAK”.

The solution is as Dennis wrote, take the VA out of Congressional oversight (?) and make the VA accountable to the law through the court system. BUT, that will not happen because congressmen don’t want to give up the power and money to NOT have a ‘committee’ overseeing veteran affairs — and the unelected officials at the VA will not want to give up the power it has over our elected officials, who must be re-elected every 2 years and who receive extra money for ‘serving’ on these committees. So our Congressmen/women and the VA, with a lot of encouragement from DOD and the whoredom of our political parties just love the status quo. Oh, some blame will be assigned with this latest fiasco, but the end result will be that Congress will allocate more money to ‘solve’ the problem. Which means that the VA will acquire more powerful ‘unelected bureaucrats’ who will have even more power than there predecessors.
Dennis, you have the answer.

I’ve been getting this sort of treatment and I’m getting it to this day. I had to put myself in the VA hospital via the ER in July 2012. I had and still have an iron deficiency and anemia. I’ve been trying to keep on top of this and they found no reason for the blood loss. I’m at the point now that I’m going to have to go to the ER again because I’ve had a continuing drop in my levels since my discharge from the hospital in 12. I can’t get any one to address this and have complained about it continuously. I’m treated as if I have no idea what I’m talking about and I have to beg just to get a blood draw. I started complaining about this and now my new PCP (whom I have not even talked to yet) thinks that my pain meds are causing my irrational behavior. He’s sent me to the chronic Pain Management Safety Committee who have decided to punish me and my complaining by stopping my chronic pain meds. I’ve been on these for almost 2 years and you just can’t stop them, I need to be weaned off of them. I’ve had no complaints about my pain meds except for the fact that they’re like other opioids, and I feel after two years I’ve developed a tolerance and it’s not helping as much and I asked for an increase. I’ve tried to keep this on the straight and narrow and be completely upright on this to show that I’m doing what has been asked so I wouldn’t have a problem. But I was wrong. They’ve been telling me that my blood levels are fine and not to worry about them. I’m so low on iron that they’re giving me IV infusions that don’t have enough iron in them to make any difference. I ‘m losing more than they’re giving me. I ‘m pale, short of breath, can barely walk or do any thing without having to breath hard and still I get the “all OK” from my PCP.

I had same problem- levels continued to drop since 2006- went down 1 point for the last three years. All my requests to see a specialist at the VA fell on deft ears. I am 100% service connected which makes no difference. I finally went outside the VA where the hematologist is taking me seriously and I had a ct scan today for an enlarged spleen.
If I had continued to depend on the VA who knows what would happen.
I am sorry that the VA is not helping you.

After I got out of the hospital my next two blood draws were within the limits but dropping and from July 2012 to April 2014 my iron went from 119 to 22. My iron saturation is at 6% (from 26%) my ferritin is at 10 (from 97). I can barely do anything and my PCP kept telling me that things were fine and not to worry. I told him that I knew from the last time what was going to happen. Well, I guess I do know my body because the readings above were after I finally told him that the bottom was dropping out and I knew I was low. He agreed to finally have another draw and the results are as above. Then he acted so concerned and told me that if I had shortness in breathing, seeing blood, etc… to go to the ER. Duh, if he would have listened to me I would not be in the situation I am in. I am unemployed and I can not even get a job partially due to the fact I can’t do anything without breathing hard. I am getting away from the VA and getting private healthcare. I hate to do it because of the not being able to pay for the policy but I will be dead if I stay with the VA. I will check into the spleen problem and see if that is it. Thank you for giving me something to go off of. Now I just have to get someone to look and see if that is it. Stupid VA.

Oh and yes I am taking iron pills 325mG 3 times a day and still have that kind of loss. And no one in the VA health care system seemed to care. I think they were hoping I would die and then they would have more money to put into their other projects and not have to spend it on the little things like us vets.

Every VA medical center should have a oversight board that grade them on their performance and can request an inspection (unannounced) in any department at any time. The IG takes to long to investigate. This oversight board should be made up of ex military who has a stake in the care and lives of veterans.

Manslaughter Plain and simple . At least the six top directors in Phoenix should be arrested . The Veterans affairs committee will not do crap. They never will or they already would have . The VA is merely a jobs program for the federal govt. if a private hospital did this , folks would be in jail . Shinseki nor Obama have come out in outrage over this . Let Humana run the VA healthcare . Just read the VA’s own IG reports. They are all crooked.

Dennie, You are 100% correct. The VA will Never Do anything to any of these criminals nor will they change in the way the treat Vets. The VA is just as Crooked as the rest Govt. The Only way that this Can be fixed is if the VA is taken out of Congressional Hands like Dennis said, Plus, We as Americans not just Veterans, Must, I Repeat MUST WIPE EVERY SINGLE SEAT IN THE GOVT AND START FROM SQUARE ONE! Otherwise there will Never be a change in the Corruption of this Govt and every agency within.

i agree on what you said, between wall street/ federal reserve,and congress-they hold all the cards!!!! they will see everyone dead before we clean house or put some of the power back in the common man’s hands!

Ret Master Chief(69-95) and Vietnam Vet. You are absolutely correct . The stench from that Bloated part of Big Gov’t is overwhelming. Clean House(Both) and fumigate and start all over. Tired of being screwed by Bureaucratic Imbeciles. Get rid of all of them. Hire some Vets who have been through the Mill. Until that happens,it will be the same old story.

The VA is so confident in their corruption and crimes that they truly believe they will continue to get by with it. They have crossed a threshold that they they are not aware of. Even with Medical Center directors and other staff currently on the run from questioning and arrest, they still think it is business as usual. But, it isn’t. If you read just the articles by Benjamin Krause here in the past few months you see a pattern of major impact compared to the past couple of years. The VA’s problem is they are being investigated and brought to task by a few Congressional investigations that are actually doing something for a change. The FBI is still involved in major arrest cases and additional criminal investigations that we were just reading about here less than two weeks ago. My own Congressman’s offices, has gotten search warrants and obtained highly incriminating evidence against the VA very recently. There has been some major breakthroughs as a result of his investigation and by that of his staff, and much more is coming. The FBI and even the VA CID have recently realized that they have no choice but to start going after the criminal enterprise within the VA. They are very smart people and just like VA whistle blowers, there are FBI and CID whistle blowers. Watch for soon-coming arrests and real results for a change. And on the recent 40 deaths and secret lists, watch for that to turn out to be the very tip of the iceberg, and infinitely more criminal and sinister than it appears now. Bonus systems for denying VA claims involving flat out murder for hire for Dr. Death Teams backed up by Administrative Death Teams, just watch for it. It has come down to the FBI knowing that if they don’t start making some serious arrests on information they already have, and the DOJ following through with effective prosecutions that surely will end with many convictions, they will face the same. They are not about to let the con artists running the show at the VA get by with murder while they go down for aiding them. Congress doesn’t want this murder for hire and bonuses scheme being associated with them then sending them to prison. The VA doctor who blew the whistle is the one who should get a bonus, and we as veterans and taxpayers, including you, your friends and relatives, and every American who cares anything about veterans and their direct link to national defense social models, need to spread the word on that.

Every day I hear one horror story after another about the va. I have fought them and the US army ever since I returned from Iraq in 2006. When I first returned all I wanted was yo be fixed. But we all know how that is. The va is not there to fix us but to patronize us just enough to keep us from taking our skills we learned and turning them against the establishment that used us to begin with. I declared war on the va when I found out that all t hey wanted was for me t o go away. So far I am winning my personal battle (100% p&t). I have tried my best to help every veteran that I meet that needs help working through the maze of paper work and mis-guidance the va uses to deter us from getting our hard earned benefits. I am now in law school working to a degree so I can take the fight to the next level. It is apparent the government won’t do anything. Nor from what I have seen neither do the so called service organizations (e.g.. Dav, dfw, etc.). At some point in the near future it is going to take all of us that swore an oath to protect t his country and our constitution t o come together in one effort o eradicate our country of the viruses we have in office. The tree of freedom has needed to be shaken for some time now.

The VA has several ongoing major construction projects (Orlando, New Orleans, Denver, etc) that are now running on massive (billions of dollars) cost overrun, not to mention the years of delays toward completion. So how do you think the VA can come up with the billions of dollars to replace what has been loss through outright theft, fraud, waste, and abuse? Of course, the VA has to cut cost on the actual services provided (in this Phoenix case, not provided) to the veterans and also kill a few of them, that’s how! I blame it all on Jeff Miller, the Chairman of the House VA Committee for not doing anything about the criminals in VA even though he has had all the evidence of the VA Officials’ crime for quite sometime. I strongly suspect he is being “paid” to do nothing.

Robert, you sound angry.
However you feel about rotting fish, President Obama is still YOUR president and…. he is doing his part to minimize the manufacturing of more disabled American vets by getting the US out of those crazy mid-eastern wars. If you are going to bitch about a presidential administration, lets talk about all the chicken hawks who started this last crop of wars. The Cheney gang of 1960’s draft dodgers, who didn’t have the balls to take a chance of dying in Viet Nam, had no problem sending our kids to fight a war that stunk as bad as the war they evaded in 1967. At least this latest presidential administration (that doesn’t have any military experience) doesn’t pretend to be GI Joe bad asses.
Here’s bigger question, why is the VA system so convoluted with systemic ineptitude?

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